title: Rapid bedside triage does not affect the delivery of pain medication for extremity pain in the pediatric emergency department.
abstract: OBJECTIVE
  Rapid bedside triage (RBT), rather than traditional waiting room triage (WRT), is becoming a "best practice" in managing emergency department (ED) patient flow, yet little is known about the impact of this process on other aspects of patient care. This study was designed to compare overall adherence to an existing nurse-driven ED pain protocol after changing from a WRT to an RBT process.
  
  
  METHODS
  On November 1, 2011, the triage process at our institution changed from a traditional WRT system to an in-department RBT allowing for comparison of the 2 groups. A retrospective chart review assessing compliance with the department's pain protocol was performed on all patients presenting to the ED during October and November 2011, representing the immediate time periods before and after the implementation of the change in triage process. Patients younger than 19 years, with complaint of isolated extremity pain or injury, were included in this analysis. Compliance was defined as patients having a pain score assessed and pain medication given for scores of 4 or more within 30 minutes of arrival.
  
  
  RESULTS
  In total, 546 patients were identified for inclusion in the study; 306 received traditional WRT, and 240 received RBT. Compliance with the pain protocol was seen in 54.6% of patients receiving WRT versus 57.5% receiving RBT (P = 0.50).
  
  
  CONCLUSIONS
  Changing from a traditional WRT process to an in-department RBT process resulted in no change in the compliance with the existing pain protocol.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MO, USA. thomas_s@kids.wustl.edu
authors.forename: Scott M
authors.initials: SM
authors.lastname: Thomas
authors.forename: James M
authors.initials: JM
authors.lastname: Gerard
authors.forename: Robert G
authors.initials: RG
authors.lastname: Flood
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005121:Extremities / Q000293:injuries; D005260:Female; D050723:Fractures, Bone / Q000150:complications; D019983:Guideline Adherence; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000451:nursing*; D059408:Pain Management / Q000451:nursing; D019095:Point-of-Care Systems / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration*
chemical_list: D000700:Analgesics